423 Alternating and combined antipyretics effective for febrile children

May 10, 2014

PEARLS 423, February 2014, written by Brian R McAvoy

Clinical question
How effective are alternating and combined paracetamol and ibuprofen for treating fever in children (aged 6 to 14 years)?

Bottom line
Compared with giving ibuprofen or paracetamol alone, giving both medications together was more effective at lowering temperature for the first 4 hours after treatment, but did not reduce discomfort or distress. Giving a single agent and then a further dose of the alternative was more effective at lowering temperature for the first 3 hours after the second dose, and reduced discomfort. Only 1 small trial compared alternating therapy with combined therapy and found no advantage with either. There were no serious adverse events directly attributed to the medications.

Caveat
There were only 6 studies included in the review. The levels of evidence were of moderate quality in 2 studies and of low quality in the other 4 studies. There was a large amount of variation between the trials in medication dosage, regimens of administration and frequency and type of assessment.

Context
Health professionals frequently recommend fever treatment regimens that either combine or alternate paracetamol with other treatments.

Cochrane Systematic Review
Wong T et al. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Reviews, 2013, Issue 10. Art. No.: CD009572.DOI: 10.1002/14651858. CD009572.pub2. This review contains 6 studies involving 915 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.